Nocturnal Oximetry and Transcutaneous Carbon Dioxide in Home-Ventilated Neuromuscular Patients

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Abstract:

BACKGROUND: Pulse oximetry alone has been suggested to determine which patients on home mechanical ventilation (MV) require further investigation of nocturnal gas exchange. In patients with neuromuscular diseases, alveolar hypoventilation (AH) is rarely accompanied with ventilation-perfusion ratio heterogeneity, and, therefore, oximetry may be less sensitive for detecting AH than in patients with lung disease. OBJECTIVE: To determine whether pulse oximetry (SpO2 ) and transcutaneous carbon dioxide (PtcCO2 ) during the same night were interchangeable or complementary for assessing home MV efficiency in patients with neuromuscular diseases. METHODS: Data were collected retrospectively from the charts of 58 patients with chronic neuromuscular respiratory failure receiving follow-up at a home MV unit. SpO2 and PtcCO2 were recorded during a 1-night hospital stay as part of standard patient care. We compared AH detection rates by PtcCO2 , SpO2 , and both. RESULTS: AH was detected based on PtcCO2 alone in 24 (41%) patients, and based on SpO2 alone with 3 different cutoffs in 3 (5%), 8 (14%), and 13 (22%) patients, respectively. Using both PtcCO2 and SpO2 showed AH in 25 (43%) patients. CONCLUSIONS: Pulse oximetry alone is not sufficient to exclude AH when assessing home MV efficiency in patients with neuromuscular diseases. Both PtcCO2 and SpO2 should be recorded overnight as the first-line investigation in this population.

Keywords: blood gas monitoring; hypoventilation; mechanical ventilation; neuromuscular diseases; oximetry; transcutaneous

Document Type: Research Article

DOI: http://dx.doi.org/10.4187/respcare.01658

Affiliations: Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale et Centre d’Investigation Clinique et d’Innovation Technologique, Unité 805 Institut National de la Santé et de la Recherche Médicale, Hôpital Raymond Poincaré, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France

Publication date: September 1, 2012

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